At the heart of a robotic operation, at the CHU cardiological hospital

Bordeaux: At the heart of a robotic operation at the CHU cardiological hospital – 20 Minutes

  • The Bordeaux University Hospital has just been equipped with two new latest generation robots.
  • “About 15 to 20% of cardiac surgery interventions can potentially be performed with the robot,” explains the head of the cardiology service, Professor Louis Labrousse.
  • Thanks to the robot, an operation of the heart is carried out with a small incision of three centimeters, whereas without it it would be necessary to make an opening of the rib cage.

A “dive into the heart of the patient, unparalleled in open surgery”. “More precise surgical procedures”. Prof. Louis Labrousse, head of the cardiac surgery department at Bordeaux University Hospital, raved about his new assistant, a
surgical robot latest generation, which has been equipping its service since last December. It is one of the two new robots that the Bordeaux University Hospital has just acquired, for 3.4 million euros.

Exceptionally, 20 Minutes was able to follow a heart operation performed with this robotic assistant, at the CHU cardiological hospital, located on the Haut-Lévêque site in
Pessac. It was a
mitral valve repair, which is located in the atrium and left ventricle, in a patient in his 50s.

Like in an airplane cockpit

Without a robot, this intervention would have required sternotomies, an opening in the rib cage. There, a simple incision of three centimeters is enough, to allow the mini-camera to slide, and the instruments attached to the four arms of the robot which are controlled from a console. “The operation is a little longer than for a sternotomy, four hours instead of three, because there is a succession of small gestures to be made which require more time, and because we must communicate to three” explains Professor Louis Labrousse. The head of the cardiac surgery department supervises two surgeons during the operation, one at the controls behind the console, the other at the patient’s level. In maximum concentration, all three exchange, confirm each gesture made. Like in an airplane cockpit.

Cardiac surgeon in Brussels, specialized in robotic surgery since 2001, Jean-Luc Jansens controls the surgical instruments placed at the end of the robot’s four arms from his console. “Like in a video game,” he jokes. “We are connected inside the heart first with the eyes, thanks to a three-dimensional camera which offers us a depth of field allowing us to appreciate the distance of an object or an organ in relation to the body. ‘other’, he explains. The quality of the image, also reproduced on two large screens placed in the operating room, is breathtaking. The heart and the instruments are magnified ten times to offer the greatest precision to the surgeon.

“Master of the machine connected to the patient”

“We are also connected by the hands with two joysticks which make it possible to close or open the pliers, to cut wires, and also to control the camera by zooming in and out, continues Jean-Luc Jansens. Finally, we are connected by the feet, with pedals, one also serving for the camera and the other serving to coagulate, to stop possible bleeding. Through this console, we are therefore in control of the machine connected to the patient. “

A surgical robot, at Bordeaux University Hospital – Mickaël Bosredon / 20 Minutes

Mitral valve surgery is a relatively common operation, but it remains delicate since the patient’s heart must be stopped. “This is why it is necessary for an expert in cardiac surgery to stand near the patient, to check the knots that are being made from a distance, to cut the threads, to present the instruments or organs in such a way. that we can see better, adds the Belgian surgeon. It really is an interconnection between the two of us. “And at any time,” if we realize that there is any problem, we can remove the machine in three seconds and start a classic procedure again, “insists Professor Louis Labrousse.

540 ° arm articulation

Surgeons also explain that the term “robot” can be misleading, compared to what is actually practiced. “He is a surgical assistant,” insists Jean-Luc Jansens. It is only an instrument, and in reality, there is no truly automated gesture, everything is controlled by the surgeon. What the robot can do on its own is to warn us of a danger if a certain gesture could lead to a collision or a problem for the patient. “

A luxury assistant, all the same. “The advantage of the robot for this technique is significant thanks to the three-dimensional view in the thorax, and thanks to the instruments which have a 540 ° articulation, that is to say that the arms can turn one and a half times. , which humans cannot do, ”explains Jean-Luc Jansens.

“Patients recover between two and three more quickly”

Even more than for the surgeon, it is for the patient that the benefits of the robot are the most impressive. “It’s minimally invasive surgery,” explains Professor Louis Labrousse. A sternotomy results in a much longer postoperative recovery time, and more severe chronic pain. There, patients typically recover between two and three times faster. “

At the Bordeaux University Hospital, “around 15 to 20% of cardiac surgery interventions can potentially be performed with the robot and in particular all mitral and tricuspid valve surgery,” explains Professor Louis Labrousse. Its service “covers the entire spectrum of cardiac surgery” and performs 1,500 operations each year, making it the largest cardiology service in France.

With the acquisition of two new latest generation surgical robots, the Bordeaux University Hospital is now equipped with four machines, for multidisciplinary use: in urology, gynecology, digestive / colorectal surgery, cardiac surgery, thoracic surgery, and ENT. Which also makes it, apart from AP-HP (Hospitals of Paris), the largest robotic surgery center in France.

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